基于临床指南的临床决策支持系统的设计与实现
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摘要
临床决策支持系统的应用可以有效解决临床医生知识的局限性问题、减少人为疏忽、相对降低医疗费用。临床指南的重要性已经得到广泛认可,它的科学性和规范性为临床决策支持系统提供了可靠的知识来源,为医疗质量提供了保障。尽管基于临床指南的临床决策支持系统的价值得到普遍认同,但无论国内外,在临床实际中投入广泛长期应用的系统并不多,归纳起来有两方面的原因:一是知识库的构建不能满足临床医生的需求,二是大多数系统与临床工作流脱节,在技术上没有与电子病历集成,导致系统提供决策支持的方式不符合临床医生的行为习惯,降低了临床医生使用临床决策支持系统的积极性。
针对以上这两个问题,本文的主要研究内容为:
设计一个从人工到自动化的统一流程构建临床指南知识库,解决知识库构建方法的通用性。
分析临床决策支持系统提供决策支持的合理方式和契机,设计本地化映射工具解决临床决策支持系统与异构电子病历的集成。
以上述两个问题的解决为基础,设计了基于临床指南的临床决策支持系统的架构方案,通过系统在代谢综合征诊疗中的应用,证明了方案的可行性。最后,在医院的临床科室中,对这一系统的临床应用效果开展评估,并从多个角度分析了评估结果。结果表明,系统的实现符合设计目标,为临床医生尤其是非专科医生、低年资医生提供了决策支持作用,并且有助于提高整体的医疗水平,减少医疗差错,促进医疗服务质量的提高。
The implementation of clinical decision support system can effectively break through the clinicians' limitations of medical knowledge; avoid man-made mistake and cut down medical costs. The importance of clinical guidelines has already been widely recognized, owing to its scientific and normative features which make them to be suitable source of medical knowledge. The value of clinical decision support system based on clinical guideline is widely accepted. However, at home and abroad, most systems can not be applied in daily use too long. The insufficient of knowledge base which system owned can not satisfy clinician's need explains for one of this reason. The other reason is that most existed systems disengaged the clinicians from the daily work and system can not integrated with electronic medical record system. Thus, the inconvenience brings down clinicians' enthusiasm of using system.
The work of this dissertation includes:
1) Design a flow to construct medical knowledge base from manual to automated way.
2) Analysis suitable decision support type and time according to clinical workflow. Design a localization mapping tool for clinical decision support system integration to heterogeneous electronic medical record system.
After resolve these two problems, design the architecture of clinical decision support system based on clinical guideline. The feasibility of this architecture is proved by its application in the diagnosis and treatment of metabolic syndrome. Finally, this clinical application value of this system is evaluated in some departments of hospital. The results reveal that this system accord with the design aim. The system assists clinicians effectively especially for who are not seasoned, improves their level of diagnosis and treatment, decrease man-made mistake and the quality of medical care is improved finally.
针对以上这两个问题,本文的主要研究内容为:
设计一个从人工到自动化的统一流程构建临床指南知识库,解决知识库构建方法的通用性。
分析临床决策支持系统提供决策支持的合理方式和契机,设计本地化映射工具解决临床决策支持系统与异构电子病历的集成。
以上述两个问题的解决为基础,设计了基于临床指南的临床决策支持系统的架构方案,通过系统在代谢综合征诊疗中的应用,证明了方案的可行性。最后,在医院的临床科室中,对这一系统的临床应用效果开展评估,并从多个角度分析了评估结果。结果表明,系统的实现符合设计目标,为临床医生尤其是非专科医生、低年资医生提供了决策支持作用,并且有助于提高整体的医疗水平,减少医疗差错,促进医疗服务质量的提高。
The implementation of clinical decision support system can effectively break through the clinicians' limitations of medical knowledge; avoid man-made mistake and cut down medical costs. The importance of clinical guidelines has already been widely recognized, owing to its scientific and normative features which make them to be suitable source of medical knowledge. The value of clinical decision support system based on clinical guideline is widely accepted. However, at home and abroad, most systems can not be applied in daily use too long. The insufficient of knowledge base which system owned can not satisfy clinician's need explains for one of this reason. The other reason is that most existed systems disengaged the clinicians from the daily work and system can not integrated with electronic medical record system. Thus, the inconvenience brings down clinicians' enthusiasm of using system.
The work of this dissertation includes:
1) Design a flow to construct medical knowledge base from manual to automated way.
2) Analysis suitable decision support type and time according to clinical workflow. Design a localization mapping tool for clinical decision support system integration to heterogeneous electronic medical record system.
After resolve these two problems, design the architecture of clinical decision support system based on clinical guideline. The feasibility of this architecture is proved by its application in the diagnosis and treatment of metabolic syndrome. Finally, this clinical application value of this system is evaluated in some departments of hospital. The results reveal that this system accord with the design aim. The system assists clinicians effectively especially for who are not seasoned, improves their level of diagnosis and treatment, decrease man-made mistake and the quality of medical care is improved finally.
引文
1 赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
2 van Bemmel,J.H.Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:220.
3 李峰,庄军,刘侃等.医学专家决策支持系统的发展与现状综述[J].医学信息,2007,20(4):527-529
4 van Bemmel,J.H.& Musen,M.A.Handbook of medical informatics[M].Netherlands:Bohn Stafleu Van Loghum,1997.
5 Mendonca,E.A.Clinical decision support systems:perspectives in dentistry[J].Journal of Dental Education.2004:589-597.
6 Shortliffe,E.H.,Axline,S.G.,Buchanan,B.G.et al.An artificial intelligence program to advise physicians regarding antimicrobial therapy[J].Computers and Biomedical Research,1973,6(6):544-560.
7 Miller,R.A.,Pople,H.E.& Myers,J.D.Internist-I,an experimental computer-based diagnostic consultant for general internal medicine[J].N Engl J Med,1982,307(8):468-476.
8 Barnett,G.O.,Hoffer,E.P.,Packer,M.S.et al.DXPLAIN-demostration and discussion of a diagnostic clinical decision support system[A].Proc Annu Symp Comput Appl Med Care[C],1991:878-885.
9 Umbaugh,S.E.,Moss,R.H.& Stoecker,W.V.Applying artificial intelligence to the identification of variegated coloring in skin tumors[J].IEEE Engineering in Medicine and Biology Magazine,1991,10(4):57-62.
10 Provan,G.M.& Clarke,J.R.Dynamic network construction and updating techniques for the diagnosis of acute abdominal pain[J].IEEE Trans on Pattern Analysis and Machine Intelligence,1993,15(3):299-306.
11 Birndorf,N.I.,Pentecost,J.O.,Coakley,J.R.et al.An expert system to diagnose anemia and report results directly on hematology forms[J].Computers and Biomedical Research,1996,29(1):16-26.
12 Wells,D.M.,Walrath,D.& Craighead,P.S.Improvement in tangential breast planning efficiency using a knowledge-based expert system[J].Med Dosim,2000,25(3):133-138.
13 赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
14 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15
15 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15
16 Hripcsak,G.,Ludemann,P.,Pryor,T.A.et al.Rationale for the Arden syntax[J].Computers and Biomedical Research,1994,27(4):291-324.
17 Hripcsak,G..Writing Arden syntax medical logic[J].Computers in Biology and Medicine,1994,24(5):331-363.
18 Haug,P.J.,Rocha,B.H.& Evans,R.S.Decision support in medicine:lessons from the HELP system[J].International Journal of Medical Informatics,2003,69(2-3):273-284.
19 Terenziani,P.,Carlini,C.& Montani,S.Towards a comprehensive treatment of temporal constraints in clinical guidelines[A].Ninth International Symposium on Temporal Representation and Reasoning[C],2002:20-27.
20 Musen,M.A.,Tu,S.W.,Das,A.K.et al.EON:a component-based approach to automation of protocol directed therapy[J].Journal of the American Medical Informatics Association,1996,3(6):367-388.
21 Tu,S.W.& Musen,M.A.A flexible approach to guideline modeling[A].Proc.AMIA Symp[C],1999:420-424.
22 Fox,J.,Johns,N.,Lyons,C.et al.PROforma:a general technology for clinical decision support systems[J].Computer Methods and Programs in Biomedicine,1997,54(1-2):59-67.
23 Peleg,M.,Boxwala,A.A.,Ogunyemi,O.et al.GLIF3:the evolution of a guideline representation format[A].Proc.AMIA Symp[C],2000:645-649.
24 Peleg,M.,Boxwala,A.A.,Tu,S.,et al.The intermed approach to sharable computer-interpretable guidelines[J].Journal of the American Medical Informatics Association,2004,11(1):1-10.
25 Ohno-Machado,L.,Gennari,J.H.,Murphy,S.N.et al.The guideline interchange format:a model for representing guidelines[J].Journal of the American Medical Informatics Association,1998,5(4):357-372.
26 Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.The NEWGuide project:guidelines,information sharing and learning from exceptions[A].Proceedings AIME[C],2003.
27 Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.A guideline management system[A].11th World Congress on Medical Informatics[C],2004:28-32.
28 Johnson,P.D.,Tu,S.,Booth,N.et al.Using scenarios in chronic disease management guidelines for primary care[A].Proc.AMIA Symp[C],2000:389-393.
29 Tu,S.W.,Campbell,J.& Musen,M.A.The SAGE guideline modeling:motivation and methodology[J].Stud Helath Technol Inform..2004,101:161-171.
30 雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
31 Feigenbaum,E.A.The art of artificial intelligence:i.themes and case studies of knowledge engineering[R].Stanford Heuristic Programming Project,1977.
32 van Bemmel,J.H.,Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:220.
33 赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
34 沈宁,贺蓓.临床实践指南:客观与规范[J].中华医学杂志,2007,87(34):2377-2379.
35 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15.
36 Wang,D.,Peleg,M.,Tu,S.W.et al.Representation primitives,process models and patient data in computer-interpretable clinical practice guidelines:a literature review of guideline representation models[J].International Journal of Medical Informatics,2002,68(1-3):59-70.
37 Peleg,M.,Boxwala,A.A.,Tu,S.,et al.The intermed approach to sharable computer-interpretable guidelines[J].Journal of the American Medical Informatics Association,2004,11(1):1-10.
38 陈海燕.工作流程图的制定在临床护理中的应用[J].青海医药杂志,2006,36(10):50-51.
39 刘芳,张欣红,李峥.制定工作流程图提高护理服务质量[J].护理管理杂志,2004,4(3):20-21.
40 Hunt,R.H.,Xiao,S.D.,Megraud,F.et al.世界胃肠病学组织(WGO—OMGE)临床指南——发展中国家幽门螺杆菌感染[J].胃肠病学,2007,12(1):40-52.
41 石俊,江华,何振扬.ICU肠外肠内营养支持指南流程图[A].天津全国指南工作会[C],2006:1-4.
42 GB/T 1526-1989,信息处理数据流程图、程序流程图、系统流程图、程序网络图和系统资源图的文件编制符号及约定[S].
43 郭玮,基于Arden语言的临床诊疗指南的可视化表达[D].硕士学位论文,浙江大学,2007.
44 van der Maas,A.A.F.,Ter Hofstede,A.H.M.,& Ten Hoopen,A.J.Requirements for medical modeling languages[J].Journal of the American Medical Informatics Association,2001,8:146-162.
45 Noy,N.F.,& McGuinness,D.L.Ontology development 101:a guide to creating your first ontology[R].Stanford Knowledge Systems Laboratory Technical Report KSL-01-05 and Stanford Medical Informatics Technical Report SM1-2001-0880,2001.
46 Tu.S.W.,Campbell,J.R.,Glasgow,J.et al.The SAGE guideline model:achievements and overview[J].Journal of the American Medical Informatics Association,2007,14(5):589-598.
48 Wu,B.F.,Lu,X.D.& Duan,H.L.An automatic knowledge acquisition mechanism for independent inference engine module of clinical decision support system[A].ICBBE 2008[C],2008:1293-1296.
49 徐大华,刘晶.基于工作流的临床诊治系统的开发[J].计算机工程与设计,2007,28(6):1453-1455.
50 Osheroff.J.A.,Pifer,E.A.,Sittig.D.F.et al.Clinical Decision Support Implementer's Workbook[A].HIMSS 2004[C].Chicago:2004.
51 van Bemmel,J.H.,Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:2-3.
52 雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
53 Chabat,F.,Hansell,D.M.& Yang,G Z.Computerized decision support in medical image[J].IEEE Engineering in Medicine and Biology,2000,(5):86-96.
54 田慧.代谢综合征的病因和防治原则[J].人民军医,2005,48(8):473-475.
55 Chew,G.T.,Gan,S.K.& Watts,G.F.Revisiting the metabolic syndrome[J].Medical Journal of Australia,2006,185(8):445-449.
56 Lowe,B.,Hochlehnert,A.& Nikendei,C.Metabolic syndrome and depression[J].Ther Umsch,2006,63(8):521-527.
57 Gu,D.,Reynolds.K.,Wu,X.,et al.Prevalence of the metabolic syndrome and overweight among adults in China[J].The Lancet,2005,365(9468):1398-1405.
[1]Barnett,G.O.,Hoffer,E.P.,Packer,M.S.et al.DXPLAIN-demostration and discussion of a diagnostic clinical decision support system[A].Proc Annu Symp Comput Appl Med Care[C],1991:878-885.
[2]Birndorf,N.I.,Pentecost,J.O.,Coakley,J.R.et al.An expert system to diagnose anemia and report results directly on hematology forms[J].Computers and Biomedical Research,1996,29(1):16-26.
[3]Chabat,F.,Hansell,D.M.& Yang,G.Z.Computerized decision support in medical image[J].IEEE Engineering in Medicine and Biology,2000,(5):86-96.
[4]Chew,G.T.,Gan,S.K.& Watts,G.F.Revisiting the metabolic syndrome[J].Medical Journal of Australia,2006,185(8):445-449.
[5]Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.A guideline management system[A].11th World Congress on Medical Informatics[C],2004:28-32.
[6]Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.The NEWGuide project:guidelines,information sharing and learning from exceptions[A].Proceedings AIME[C],2003.
[7]Feigenbaum,E.A.The art of artificial intelligence:i.themes and case studies of knowledge engineering[R].Stanford Heuristic Programming Project,1977.
[8]Fox,J.,Johns,N.,Lyons,C.et al.PROforma:a general technology for clinical decision support systems[J].Computer Methods and Programs in Biomedicine,1997,54(1-2):59-67.
[9]GB/T 1526-1989,信息处理数据流程图、程序流程图、系统流程图、程序网络图和系统资源图的文件编制符号及约定[S].
[10]Giarratano,J.C.&Riley,G.D.著.印鉴,陈忆群,刘星成译.专家系统:原理与编程[M],北京:机械工业出版社,2006:235-236.
[11]Gu,D.,Reynolds,K.,Wu,X.,et al.Prevalence of the metabolic syndrome and overweight among adults in China[J].The Lancet,2005,365(9468):1398-1405.
[12]Haug,P.J.,Rocha,B.H.& Evans,R.S.Decision support in medicine:lessons from the HELP system[J].International Journal of Medical Informatics,2003,69(2-3):273-284.
[13]Hripcsak,G..Writing Arden syntax medical logic[J].Computers in Biology and Medicine,1994,24(5):331-363.
[14]Hripcsak,G.,Ludemann,R,Pryor,T.A.et al.Rationale for the Arden syntax[J].Computers and Biomedical Research,1994,27(4):291-324.
[15]Hunt,R.H.,Xiao,S.D.,Megraud,F.et al.世界胃肠病学组织(WGO—OMGE)临床指南——发展中国家幽门螺杆菌感染[J].胃肠病学,2007,12(1):40-52.
[16]Johnson,P.D.,Tu,S.,Booth,N.et al.Using scenarios in chronic disease management guidelines for primary care[A].Proc.AMIA Symp[C],2000:389-393.
[17]Lowe,B.,Hochlehnert,A.& Nikendei,C.Metabolic syndrome and depression[J].Ther Umsch,2006,63(8):521-527.
[18]Mendonca,E.A.Clinical decision support systems:perspectives in dentistry[J]. Journal of Dental Education, 2004: 589-597.
[19] Miller, R. A., Pople, H. E. & Myers, J. D. Internist-I,an experimental computer-based diagnostic consultant for general internal medicine[J]. N Engl J Med, 1982, 307(8): 468-476.
[20] Musen, M. A., Tu, S. W., Das, A. K. et al. EON: a component-based approach to automation of protocol directed therapy[J]. Journal of the American Medical Informatics Association, 1996,3(6): 367-388.
[21] Noy, N. F., & McGuinness, D. L. Ontology development 101: a guide to creating your first ontology[R]. Stanford Knowledge Systems Laboratory Technical Report KSL-01-05 and Stanford Medical Informatics Technical Report SM1-2001-0880,2001.
[22] Ohno-Machado, L., Gennari, J. H., Murphy, S. N. et al. The guideline interchange format: a model for representing guidelines[J]. Journal of the American Medical Informatics Association, 1998, 5(4): 357-372.
[23] Osheroff, J. A., Pifer, E. A., Sittig, D. F. et al. Clinical Decision Support Implemented Workbook[A]. HIMSS 2004[C], Chicago: 2004.
[24] Peleg, M., Boxwala, A. A., Ogunyemi, O. et al. GLIF3: the evolution of a guideline representation format[A]. Proc. AMIA Symp[C], 2000: 645-649.
[25] Peleg, M., Boxwala, A. A., Tu, S., et al. The intermed approach to sharable computer-interpretable guidelines[J]. Journal of the American Medical Informatics Association, 2004,11 (1):1 -10.
[26] Provan, G. M. & Clarke, J. R. Dynamic network construction and updating techniques for the diagnosis of acute abdominal pain[J]. IEEE Trans on Pattern Analysis and Machine Intelligence, 1993,15(3): 299-306.
[27] Shortliffe, E. H., Axline, S. G., Buchanan, B. G et al. An artificial intelligence program to advise physicians regarding antimicrobial therapy[J]. Computers and Biomedical Research, 1973, 6(6): 544-560.
[28] Terenziani, P., Carlini, C. & Montani, S. Towards a comprehensive treatment of temporal constraints in clinical guidelines[A]. Ninth International Symposium on Temporal Representation and Reasoning[C], 2002: 20-27.
[29] Tu, S. W., Campbell, J. & Musen, M. A. The SAGE guideline modeling:motivation and methodology[J]. Stud Helath Technol Inform., 2004, 101:161-171.
[30] Tu, S. W., Campbell, J. R., Glasgow, J. et al. The SAGE guideline model:achievements and overview[J]. Journal of the American Medical Informatics Association, 2007, 14(5): 589-598.
[31] Tu, S.W. & Musen, M. A. A flexible approach to guideline modeling[A]. Proc.AMIA Symp[C], 1999: 420-424.
[32] Umbaugh, S. E., Moss,R.H. & Stoecker, W. V. Applying artificial intelligence to the identification of variegated coloring in skin tumors[J]. IEEE Engineering in Medicine and Biology Magazine, 1991, 10(4): 57-62.
[33] van Bemmel, J. H. & Musen, M. A. Handbook of medical informatics[M]. Netherlands: Bohn Stafleu Van Loghum, 1997.
[34] van Bemmel, J. H., Musen, M. A.主编,包含飞,郑学侃主译.医学信息学 [M].上海:上海科学技术出版社,2002:2-3,220.
[35]van der Maas,A.A.F.,Ter Hofstede,A.H.M.,& Ten Hoopen,A.J.Requirements for medical modeling languages[J].Journal of the American Medical Informatics Association,2001,8:146-162.
[36]Wang,D.,Peleg,M.,Tu,S.W.et al.Representation primitives,process models and patient data in computer-interpretable clinical practice guidelines:a literature review of guideline representation models[J].International Journal of Medical Informatics,2002,68(1-3):59-70.
[37]Wells,D.M.,Walrath,D.& Craighead,P.S.Improvement in tangential breast planning efficiency using a knowledge-based expert system[J].Med Dosim,2000,25(3):133-138.
[38]Wu,B.F.,Lu,X.D.& Duan,H.L.An automatic knowledge acquisition mechanism for independent inference engine module of clinical decision support system[A].ICBBE 2008[C],2008:1293-1296.
[39]陈海燕.工作流程图的制定在临床护理中的应用[J].青海医药杂志,2006,36(10):50-51.
[40]郭玮,基于Arden语言的临床诊疗指南的可视化表达[D].硕士学位论文,浙江大学,2007.
[41]何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15.
[42]雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
[43]李峰,庄军,刘侃等.医学专家决策支持系统的发展与现状综述[J].医学信息,2007,20(4):527-529.
[44]刘芳,张欣红,李峥.制定工作流程图提高护理服务质量[J].护理管理杂志,2004,4(3):20-21.
[45]沈宁,贺蓓.临床实践指南:客观与规范[J].中华医学杂志,2007,87(34):2377-2379.
[46]石俊,江华,何振扬.ICU肠外肠内营养支持指南流程图[A].天津全国指南工作会[C],2006:1-4.
[47]田慧.代谢综合征的病因和防治原则[J].人民军医,2005,48(8):473-475.
[48]徐大华,刘晶.基于工作流的临床诊治系统的开发[J].计算机工程与设计,2007,28(6):1453-1455.
[49]赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
2 van Bemmel,J.H.Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:220.
3 李峰,庄军,刘侃等.医学专家决策支持系统的发展与现状综述[J].医学信息,2007,20(4):527-529
4 van Bemmel,J.H.& Musen,M.A.Handbook of medical informatics[M].Netherlands:Bohn Stafleu Van Loghum,1997.
5 Mendonca,E.A.Clinical decision support systems:perspectives in dentistry[J].Journal of Dental Education.2004:589-597.
6 Shortliffe,E.H.,Axline,S.G.,Buchanan,B.G.et al.An artificial intelligence program to advise physicians regarding antimicrobial therapy[J].Computers and Biomedical Research,1973,6(6):544-560.
7 Miller,R.A.,Pople,H.E.& Myers,J.D.Internist-I,an experimental computer-based diagnostic consultant for general internal medicine[J].N Engl J Med,1982,307(8):468-476.
8 Barnett,G.O.,Hoffer,E.P.,Packer,M.S.et al.DXPLAIN-demostration and discussion of a diagnostic clinical decision support system[A].Proc Annu Symp Comput Appl Med Care[C],1991:878-885.
9 Umbaugh,S.E.,Moss,R.H.& Stoecker,W.V.Applying artificial intelligence to the identification of variegated coloring in skin tumors[J].IEEE Engineering in Medicine and Biology Magazine,1991,10(4):57-62.
10 Provan,G.M.& Clarke,J.R.Dynamic network construction and updating techniques for the diagnosis of acute abdominal pain[J].IEEE Trans on Pattern Analysis and Machine Intelligence,1993,15(3):299-306.
11 Birndorf,N.I.,Pentecost,J.O.,Coakley,J.R.et al.An expert system to diagnose anemia and report results directly on hematology forms[J].Computers and Biomedical Research,1996,29(1):16-26.
12 Wells,D.M.,Walrath,D.& Craighead,P.S.Improvement in tangential breast planning efficiency using a knowledge-based expert system[J].Med Dosim,2000,25(3):133-138.
13 赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
14 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15
15 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15
16 Hripcsak,G.,Ludemann,P.,Pryor,T.A.et al.Rationale for the Arden syntax[J].Computers and Biomedical Research,1994,27(4):291-324.
17 Hripcsak,G..Writing Arden syntax medical logic[J].Computers in Biology and Medicine,1994,24(5):331-363.
18 Haug,P.J.,Rocha,B.H.& Evans,R.S.Decision support in medicine:lessons from the HELP system[J].International Journal of Medical Informatics,2003,69(2-3):273-284.
19 Terenziani,P.,Carlini,C.& Montani,S.Towards a comprehensive treatment of temporal constraints in clinical guidelines[A].Ninth International Symposium on Temporal Representation and Reasoning[C],2002:20-27.
20 Musen,M.A.,Tu,S.W.,Das,A.K.et al.EON:a component-based approach to automation of protocol directed therapy[J].Journal of the American Medical Informatics Association,1996,3(6):367-388.
21 Tu,S.W.& Musen,M.A.A flexible approach to guideline modeling[A].Proc.AMIA Symp[C],1999:420-424.
22 Fox,J.,Johns,N.,Lyons,C.et al.PROforma:a general technology for clinical decision support systems[J].Computer Methods and Programs in Biomedicine,1997,54(1-2):59-67.
23 Peleg,M.,Boxwala,A.A.,Ogunyemi,O.et al.GLIF3:the evolution of a guideline representation format[A].Proc.AMIA Symp[C],2000:645-649.
24 Peleg,M.,Boxwala,A.A.,Tu,S.,et al.The intermed approach to sharable computer-interpretable guidelines[J].Journal of the American Medical Informatics Association,2004,11(1):1-10.
25 Ohno-Machado,L.,Gennari,J.H.,Murphy,S.N.et al.The guideline interchange format:a model for representing guidelines[J].Journal of the American Medical Informatics Association,1998,5(4):357-372.
26 Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.The NEWGuide project:guidelines,information sharing and learning from exceptions[A].Proceedings AIME[C],2003.
27 Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.A guideline management system[A].11th World Congress on Medical Informatics[C],2004:28-32.
28 Johnson,P.D.,Tu,S.,Booth,N.et al.Using scenarios in chronic disease management guidelines for primary care[A].Proc.AMIA Symp[C],2000:389-393.
29 Tu,S.W.,Campbell,J.& Musen,M.A.The SAGE guideline modeling:motivation and methodology[J].Stud Helath Technol Inform..2004,101:161-171.
30 雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
31 Feigenbaum,E.A.The art of artificial intelligence:i.themes and case studies of knowledge engineering[R].Stanford Heuristic Programming Project,1977.
32 van Bemmel,J.H.,Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:220.
33 赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.
34 沈宁,贺蓓.临床实践指南:客观与规范[J].中华医学杂志,2007,87(34):2377-2379.
35 何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15.
36 Wang,D.,Peleg,M.,Tu,S.W.et al.Representation primitives,process models and patient data in computer-interpretable clinical practice guidelines:a literature review of guideline representation models[J].International Journal of Medical Informatics,2002,68(1-3):59-70.
37 Peleg,M.,Boxwala,A.A.,Tu,S.,et al.The intermed approach to sharable computer-interpretable guidelines[J].Journal of the American Medical Informatics Association,2004,11(1):1-10.
38 陈海燕.工作流程图的制定在临床护理中的应用[J].青海医药杂志,2006,36(10):50-51.
39 刘芳,张欣红,李峥.制定工作流程图提高护理服务质量[J].护理管理杂志,2004,4(3):20-21.
40 Hunt,R.H.,Xiao,S.D.,Megraud,F.et al.世界胃肠病学组织(WGO—OMGE)临床指南——发展中国家幽门螺杆菌感染[J].胃肠病学,2007,12(1):40-52.
41 石俊,江华,何振扬.ICU肠外肠内营养支持指南流程图[A].天津全国指南工作会[C],2006:1-4.
42 GB/T 1526-1989,信息处理数据流程图、程序流程图、系统流程图、程序网络图和系统资源图的文件编制符号及约定[S].
43 郭玮,基于Arden语言的临床诊疗指南的可视化表达[D].硕士学位论文,浙江大学,2007.
44 van der Maas,A.A.F.,Ter Hofstede,A.H.M.,& Ten Hoopen,A.J.Requirements for medical modeling languages[J].Journal of the American Medical Informatics Association,2001,8:146-162.
45 Noy,N.F.,& McGuinness,D.L.Ontology development 101:a guide to creating your first ontology[R].Stanford Knowledge Systems Laboratory Technical Report KSL-01-05 and Stanford Medical Informatics Technical Report SM1-2001-0880,2001.
46 Tu.S.W.,Campbell,J.R.,Glasgow,J.et al.The SAGE guideline model:achievements and overview[J].Journal of the American Medical Informatics Association,2007,14(5):589-598.
48 Wu,B.F.,Lu,X.D.& Duan,H.L.An automatic knowledge acquisition mechanism for independent inference engine module of clinical decision support system[A].ICBBE 2008[C],2008:1293-1296.
49 徐大华,刘晶.基于工作流的临床诊治系统的开发[J].计算机工程与设计,2007,28(6):1453-1455.
50 Osheroff.J.A.,Pifer,E.A.,Sittig.D.F.et al.Clinical Decision Support Implementer's Workbook[A].HIMSS 2004[C].Chicago:2004.
51 van Bemmel,J.H.,Musen,M.A.主编,包含飞,郑学侃主译.医学信息学[M].上海:上海科学技术出版社,2002:2-3.
52 雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
53 Chabat,F.,Hansell,D.M.& Yang,G Z.Computerized decision support in medical image[J].IEEE Engineering in Medicine and Biology,2000,(5):86-96.
54 田慧.代谢综合征的病因和防治原则[J].人民军医,2005,48(8):473-475.
55 Chew,G.T.,Gan,S.K.& Watts,G.F.Revisiting the metabolic syndrome[J].Medical Journal of Australia,2006,185(8):445-449.
56 Lowe,B.,Hochlehnert,A.& Nikendei,C.Metabolic syndrome and depression[J].Ther Umsch,2006,63(8):521-527.
57 Gu,D.,Reynolds.K.,Wu,X.,et al.Prevalence of the metabolic syndrome and overweight among adults in China[J].The Lancet,2005,365(9468):1398-1405.
[1]Barnett,G.O.,Hoffer,E.P.,Packer,M.S.et al.DXPLAIN-demostration and discussion of a diagnostic clinical decision support system[A].Proc Annu Symp Comput Appl Med Care[C],1991:878-885.
[2]Birndorf,N.I.,Pentecost,J.O.,Coakley,J.R.et al.An expert system to diagnose anemia and report results directly on hematology forms[J].Computers and Biomedical Research,1996,29(1):16-26.
[3]Chabat,F.,Hansell,D.M.& Yang,G.Z.Computerized decision support in medical image[J].IEEE Engineering in Medicine and Biology,2000,(5):86-96.
[4]Chew,G.T.,Gan,S.K.& Watts,G.F.Revisiting the metabolic syndrome[J].Medical Journal of Australia,2006,185(8):445-449.
[5]Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.A guideline management system[A].11th World Congress on Medical Informatics[C],2004:28-32.
[6]Ciccarese,P.,Caffi,E.,Boiocchi,L.et al.The NEWGuide project:guidelines,information sharing and learning from exceptions[A].Proceedings AIME[C],2003.
[7]Feigenbaum,E.A.The art of artificial intelligence:i.themes and case studies of knowledge engineering[R].Stanford Heuristic Programming Project,1977.
[8]Fox,J.,Johns,N.,Lyons,C.et al.PROforma:a general technology for clinical decision support systems[J].Computer Methods and Programs in Biomedicine,1997,54(1-2):59-67.
[9]GB/T 1526-1989,信息处理数据流程图、程序流程图、系统流程图、程序网络图和系统资源图的文件编制符号及约定[S].
[10]Giarratano,J.C.&Riley,G.D.著.印鉴,陈忆群,刘星成译.专家系统:原理与编程[M],北京:机械工业出版社,2006:235-236.
[11]Gu,D.,Reynolds,K.,Wu,X.,et al.Prevalence of the metabolic syndrome and overweight among adults in China[J].The Lancet,2005,365(9468):1398-1405.
[12]Haug,P.J.,Rocha,B.H.& Evans,R.S.Decision support in medicine:lessons from the HELP system[J].International Journal of Medical Informatics,2003,69(2-3):273-284.
[13]Hripcsak,G..Writing Arden syntax medical logic[J].Computers in Biology and Medicine,1994,24(5):331-363.
[14]Hripcsak,G.,Ludemann,R,Pryor,T.A.et al.Rationale for the Arden syntax[J].Computers and Biomedical Research,1994,27(4):291-324.
[15]Hunt,R.H.,Xiao,S.D.,Megraud,F.et al.世界胃肠病学组织(WGO—OMGE)临床指南——发展中国家幽门螺杆菌感染[J].胃肠病学,2007,12(1):40-52.
[16]Johnson,P.D.,Tu,S.,Booth,N.et al.Using scenarios in chronic disease management guidelines for primary care[A].Proc.AMIA Symp[C],2000:389-393.
[17]Lowe,B.,Hochlehnert,A.& Nikendei,C.Metabolic syndrome and depression[J].Ther Umsch,2006,63(8):521-527.
[18]Mendonca,E.A.Clinical decision support systems:perspectives in dentistry[J]. Journal of Dental Education, 2004: 589-597.
[19] Miller, R. A., Pople, H. E. & Myers, J. D. Internist-I,an experimental computer-based diagnostic consultant for general internal medicine[J]. N Engl J Med, 1982, 307(8): 468-476.
[20] Musen, M. A., Tu, S. W., Das, A. K. et al. EON: a component-based approach to automation of protocol directed therapy[J]. Journal of the American Medical Informatics Association, 1996,3(6): 367-388.
[21] Noy, N. F., & McGuinness, D. L. Ontology development 101: a guide to creating your first ontology[R]. Stanford Knowledge Systems Laboratory Technical Report KSL-01-05 and Stanford Medical Informatics Technical Report SM1-2001-0880,2001.
[22] Ohno-Machado, L., Gennari, J. H., Murphy, S. N. et al. The guideline interchange format: a model for representing guidelines[J]. Journal of the American Medical Informatics Association, 1998, 5(4): 357-372.
[23] Osheroff, J. A., Pifer, E. A., Sittig, D. F. et al. Clinical Decision Support Implemented Workbook[A]. HIMSS 2004[C], Chicago: 2004.
[24] Peleg, M., Boxwala, A. A., Ogunyemi, O. et al. GLIF3: the evolution of a guideline representation format[A]. Proc. AMIA Symp[C], 2000: 645-649.
[25] Peleg, M., Boxwala, A. A., Tu, S., et al. The intermed approach to sharable computer-interpretable guidelines[J]. Journal of the American Medical Informatics Association, 2004,11 (1):1 -10.
[26] Provan, G. M. & Clarke, J. R. Dynamic network construction and updating techniques for the diagnosis of acute abdominal pain[J]. IEEE Trans on Pattern Analysis and Machine Intelligence, 1993,15(3): 299-306.
[27] Shortliffe, E. H., Axline, S. G., Buchanan, B. G et al. An artificial intelligence program to advise physicians regarding antimicrobial therapy[J]. Computers and Biomedical Research, 1973, 6(6): 544-560.
[28] Terenziani, P., Carlini, C. & Montani, S. Towards a comprehensive treatment of temporal constraints in clinical guidelines[A]. Ninth International Symposium on Temporal Representation and Reasoning[C], 2002: 20-27.
[29] Tu, S. W., Campbell, J. & Musen, M. A. The SAGE guideline modeling:motivation and methodology[J]. Stud Helath Technol Inform., 2004, 101:161-171.
[30] Tu, S. W., Campbell, J. R., Glasgow, J. et al. The SAGE guideline model:achievements and overview[J]. Journal of the American Medical Informatics Association, 2007, 14(5): 589-598.
[31] Tu, S.W. & Musen, M. A. A flexible approach to guideline modeling[A]. Proc.AMIA Symp[C], 1999: 420-424.
[32] Umbaugh, S. E., Moss,R.H. & Stoecker, W. V. Applying artificial intelligence to the identification of variegated coloring in skin tumors[J]. IEEE Engineering in Medicine and Biology Magazine, 1991, 10(4): 57-62.
[33] van Bemmel, J. H. & Musen, M. A. Handbook of medical informatics[M]. Netherlands: Bohn Stafleu Van Loghum, 1997.
[34] van Bemmel, J. H., Musen, M. A.主编,包含飞,郑学侃主译.医学信息学 [M].上海:上海科学技术出版社,2002:2-3,220.
[35]van der Maas,A.A.F.,Ter Hofstede,A.H.M.,& Ten Hoopen,A.J.Requirements for medical modeling languages[J].Journal of the American Medical Informatics Association,2001,8:146-162.
[36]Wang,D.,Peleg,M.,Tu,S.W.et al.Representation primitives,process models and patient data in computer-interpretable clinical practice guidelines:a literature review of guideline representation models[J].International Journal of Medical Informatics,2002,68(1-3):59-70.
[37]Wells,D.M.,Walrath,D.& Craighead,P.S.Improvement in tangential breast planning efficiency using a knowledge-based expert system[J].Med Dosim,2000,25(3):133-138.
[38]Wu,B.F.,Lu,X.D.& Duan,H.L.An automatic knowledge acquisition mechanism for independent inference engine module of clinical decision support system[A].ICBBE 2008[C],2008:1293-1296.
[39]陈海燕.工作流程图的制定在临床护理中的应用[J].青海医药杂志,2006,36(10):50-51.
[40]郭玮,基于Arden语言的临床诊疗指南的可视化表达[D].硕士学位论文,浙江大学,2007.
[41]何雨生,孙宏宇.计算机化临床实践指南研究进展[J].中国数字医学,2007,2(1):10-15.
[42]雷健波.电子病历的核心价值与临床决策支持[J].中国数字医学,2008,3(3):418-425.
[43]李峰,庄军,刘侃等.医学专家决策支持系统的发展与现状综述[J].医学信息,2007,20(4):527-529.
[44]刘芳,张欣红,李峥.制定工作流程图提高护理服务质量[J].护理管理杂志,2004,4(3):20-21.
[45]沈宁,贺蓓.临床实践指南:客观与规范[J].中华医学杂志,2007,87(34):2377-2379.
[46]石俊,江华,何振扬.ICU肠外肠内营养支持指南流程图[A].天津全国指南工作会[C],2006:1-4.
[47]田慧.代谢综合征的病因和防治原则[J].人民军医,2005,48(8):473-475.
[48]徐大华,刘晶.基于工作流的临床诊治系统的开发[J].计算机工程与设计,2007,28(6):1453-1455.
[49]赵亚利,崔树起.国际临床实践指南的研究进展[J].全科医学临床与教育,2004,2(3):176-178.